This proposal aims 1) to improve prenatal care for Spanish-speaking women in managed care populations by increasing their access to effective prenatal health education; and 2) to develop general guidelines for developing culturally and linguistically-appropriate health educational materials. We plan to pilot test a new Spanish language version of prenatal education materials entitled """"""""Beginnings"""""""" that meet national guidelines for content and sequencing of prenatal education; and to evaluate the accessibility, acceptability, and persuasiveness of these materials. We propose to randomly recruit 40 women ages 18 to 45 years, who speak Spanish as a first language, have obtained at least one prenatal care visit through CareOregon during 1997-98, have at least 6th grade education, and reside in Portland, Oregon. A list of such women will be generated from the CareOregon database. Validated instruments to be used for evaluating the appropriateness of Beginnings will include the Spanish-translated versions of the Cloze test and the Learner Verification and Revision Test. These qualitative tests will be administered in a 1 hour face-to- face interview. The interview will consist of an introduction (5 minutes); Cloze Testing (20-30 minutes); a break (5 minutes); and the Learner Verification Interview (20 minutes). The interviews will be audiotaped and participants will be assured of confidentiality. Results of the evaluation will guide our revisions of the Spanish Version of """"""""Beginnings"""""""". We will document our process of tailoring these educational materials, and will develop guidelines for producing appropriate adaptations of health educational materials for culturally diverse populations.
